PRT: The Marriage of ABA and Speech-Language Pathology Amy Fetter, MA, CCC-SLP Karen Duerk, MA, CCC-SLP Speech Language Pathologists The Joshua School The definition of PRT • A comprehensive service delivery model that uses both a developmental approach and applied behavioral analysis (ABA) procedures (Koegel, 2006). Definition of ABA • ABA is the science in which tactics derived from the principles of behavior are applied to improve socially significant behavior and experimentation is used to identify the variables responsible for the improvement of behavior. (Cooper, 2007) 7 Dimensions of ABA 1. 2. 3. 4. 5. 6. 7. Applied Behavioral Analytic Technological Conceptually systematic Effective Generality The goals of PRT: • Teach learners to respond to the many learning opportunities and social interactions that occur in the natural environment; • Decrease learners' needs for constant supervision and interaction with adults; • Promote family involvement and improve the quality of life for all family members; • Decrease the number of services delivered in separate settings that remove learners from the natural environment; Autism Internet Modules | AIM Help Email: [email protected] Copyright © 2011 | OCALI is a project of the ESC of Central Ohio The goals of PRT Cont’d: • Improve learners' academic performance, communication and language skills; • Foster learners' social interactions and friendships with typically developing peers; • Reduce learners' interfering behaviors (e.g., disruptive, repetitive, stereotypical); • Move learners toward a typical developmental trajectory by teaching a diverse number of behaviors; and • Broaden learners' interests. Historically PRT Location of intervention Segregated environments Isolated mental hospitals Natural environments Inclusion with typical peers Primary Intervention Punishment/rewards Restraints PBIS Focus on motivation Stimulus Artificial stimulus i.e., flashcards Motivational stimulus i.e., toys, books Generalization and maintenance Difficulty generalizing and maintaining new behaviors to outside environments Increase in generalization and maintenance of new behaviors to outside environments Interaction Human contact believed to be aversive to children with ASD Human contact believed to be comforting and beneficial to children with ASD Historical Connection with ABA • Distinguishing from DTT (Discrete Trial Teaching) • Basic principles of ABA used to teach receptive, expressive language, play, self-help, and social skills – Reinforcement/punishment – Shaping PRT and modern ABA Principles • PRT is using ABA strategies to increase generalization and rapid, widespread effects using these fundamental teaching tools: – Reinforcement (PBIS) – Antecedent control – Prompting with strategic plans to fade – Shaping – Chaining Treatment of the Pivotal Areas 1. 2. 3. 4. 5. Motivation Multiple cues Initiation Self- Management Empathy (in progress) Pivotal Area 1: Motivation (video clips AIM) • Core motivational variables of PRT 1) Child choice 2) Establish learner attention 3) Direct (natural) reinforcement 4) Interspersal of maintenance and acquisition trials 5) Task variation 6) Reinforcing attempts 7) Overall motivational package - Results Koegel, O’Dell, &Koegel, 1987 Increase in Generalization of Imitation and Spontaneous Utterances baseline 12 Months 20 Months 150 130 110 90 70 50 30 10 -10 DTT PRT Examples • Making choices for daily schedule • Working for reinforcement • Choices for bonus time • Social Communication • Using motivating materials to teach language Language/Motivation/Disruptive Behaviors Potential Goals for Motivation 1. When motivation is present, student will spontaneously mand (request) 20 missing items verbally, with sign, with PECS, or with SGD in at least 80% of measured opportunities across 3 different people and 2 different settings. 2. When motivation is present, student will mand (request) with 10 different adjectives, prepositions, or 2+ word utterances to gain access or protest in at least 80% of measured opportunities across 3 different people and 2 different settings. Pivotal Area 2: Responsivity to Multiple Cues • Global goal – decreasing overselectivity by distinguishing multiple relevant features of environmental stimuli. • Provide wide range of cues in learning environment. • Implication for language acquisition and social behaviors Examples Multiple cues with preschool Potential Goals for Multiple Cues 1. When in the natural environment or when shown a book, student will identify and label items based on 3 verbal components (adjectives, quantity, pronouns) with at least 80% accuracy across 3 different people and 2 different settings. 2. While engaged in the daily classroom routine (lunch, art class, recess), student will follow directions that include information about feature, function, and/or class with 80% accuracy across 3 different people and 2 different settings. Pivotal Area 3: Self-Management Definition – PBIS strategy used to reduce problem behaviors while teaching functionally equivalent replacement behaviors or to improve behavior deficits through increasing appropriate positive behaviors. Global Goal – teaching children to be aware of their behaviors and to increase ability to self-monitor, modify, and reinforce their own behaviors. Self- Management Procedures 1. 2. 3. 4. 5. Operationally define and measure the target behavior Set goals and identify reinforcers Develop self-management method-device Teach the child to use the self-management system Fade the structured device. Increases – on task behavior, social conversation behaviors, flexibility Decreases – disruptive behavior, self-stimulatory behavior Examples • Token rewards for positive behavior • Tally’s for not interrupting • Positive behavior management initial stages. Implementing with Student 1) 2) 3) 4) 5) Present the plan Provide definition of flexibility Provide explicit instructions on how to obtain points Model how to earn points Provide self-management tools(stickers, markers, point sheet) 6) Play the activity 7) Prime the child 8) Present flexibility opportunities 9) Child gives self point 10) Immediately reinforce the child Troubleshooting • Remind the child of the reinforcer • Make sure reinforcer is powerful enough • Make sure you’re starting with least demanding task • PBIS Potential Goals for Self-Management 1. When auditory prompt is sounded, student will accurately provide himself appropriate reinforcement for safe hands at the end of the time interval in at least 90% of measured opportunities across 3 different settings. 2. Using video review, student will independently label non-verbal cues relating the attention/interest of communication partner using self-management worksheet with 90% accuracy 3 videos per day for 4 weeks. Pivotal Area 4: Initiation • Question posed – What were the contributing factors to having a good prognosis with ASD?? • Initiating with questions – What’s that? – Whose is it? Where is it? What’s happening? • During groups strategically place materials/students 60 50 40 30 20 10 0 Pre Post OBSERVABLE “NORMALCY” IMPROVEMENTS Child 1 Child 2 Child 3 Child 4 10 8 6 4 2 0 Pre Post Child Child Child Child 1 2 3 4 Potential Goals for Initiation 1. When motivation is present, student will initiate a physical interaction with a peer 2 times in a 15 minute time sample across 2 different settings. 2. When interested in a peer’s toy or item, student will initiate verbally by asking “Can I play?” or a variation of such in at least 4 out of 5 measured opportunities across 3 different settings. Questions?? PRT: Best Practice for ASD • Over 200 research studies to support its effectiveness • Listed by National Research Council as one of the top 10 intervention models for ASD • Recognized as one of 4 scientifically based practices for treatment of children with autism in the US (Simpson article) Research in Self-Management Study 1: Increasing flexibility and maintaining high affect Study 2: Improving pragmatics in children with ASD using video self-management video-based interventions - appropriate model - self as model - view and evaluate performance - combined one or more of these with other interventions References • Cooper, J, Heron, T. & Heward, W. (2007). Applied Behavioral Analysis, 2nd Edition. Upper Saddle River, NJ: Pearson Education, Inc. • Koegel, Robert & Koegel, Lynn (2012). The PRT Pocket Guide – Pivotal Response Treatment for Autism Spectrum Disorders. Baltimore, MD: Paul H. Brookes. • Koegel, Robert L. (2010) .The History & Development of Pivotal Response Treatment. Bresnahan Halstead Symposia, August, 2010. • Koegel, Lynn & Koegel, Robert.,(2010). Pivotal Response Treatment: Evidence-Based Practice. Bresnahan Halstead Symposia, August, 2010. • Koegel, Lynn & Koegel, Robert. (2010).Teaching Initiations to Children with Autism. Bresnahan Halstead Symposia, August, 2010. References Cont’d: • Koegel, Lynn & Koegel, Robert (2010). 10 Strategies to Improve Socialization in Children with Autism. Bresnahan Halstead Symposia, August, 2010. • Koegel, Robert & Koegel, Lynn (2006). Pivotal Response Treatments for Autism: Communication, Social, & Academic Development. Baltimore, MD: Paul H. Brookes. • Achieving New Heights: Evidence-Based Strategies to Promote Communication, Social, and Behavioral Growth for Individuals Who Have Autism, July 26-30, 2010. • Simpson, R. (2005). Evidence-Based Practices and Students with Autism Spectrum Disorders . Focus on Autism and Other Developmental Disabilities, 20: pp. 140-149. • VB-MAPP – Language Intervention Program Based on Verbal Behavior Curriculum, August 28, 28, 2010. Thank you! • Thank you to students and staff who participated in providing videos!